Changing Patterns of Zygomaticomaxillary Complex Fractures: A Retrospective Study.

BACKGROUND: Limited research exists regarding the incidence and variations of zygomaticomaxillary complex (ZMC) fracture patterns and their correlation with the mechanism of injury. Hence, further research is indicated.

PURPOSE: The purpose of this study was to analyze the different ZMC fracture patterns in relation to its etiology using computed tomography scans.

STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study was conducted at a single institution. The medical records of maxillofacial trauma patients from 2016 to 2020 were analyzed. Patients from any gender and all age groups with complete records diagnosed with isolated ZMC fractures were included in the study.

PREDICTOR VARIABLE: The etiology of trauma was the primary predictor variable. It was categorized as road traffic accidents (RTAs), falls, interpersonal violence, fall from height, sports injuries, etc. MAIN OUTCOME VARIABLES: The primary outcome variable was the ZMC fracture patterns observed and was defined as similar to or different from the classical fracture patterns. Any type of variation noted from the classical fracture lines was defined as the secondary outcome variable.

COVARIATES: Covariates included demographic variables such as age, gender, the type of vehicle involved, the type of RTA, side of fracture, associated orbital fractures, and number of ZMC points fractured.

ANALYSES: Descriptive and bivariate statistics were used to measure association between the predictor and outcome variables using multiple proportions χ2 test. Statistical significance was defined at P value of <.05.

RESULTS: Out of the 232 scans assessed, a total of 163 cases were included in this study. A majority of the cases belonged to a range of 21 to 30 years and showed a male predilection. The most common mode of injury was found to be RTAs (88.3%). Most cases had fracture patterns different from the classical fracture patterns (65.64%). A statistically significant association was found between the types of ZMC fracture patterns and etiology of trauma (RTA P = <.0001, falls P = .0001, and interpersonal violence P = .0001). Five different variations in ZMC fracture patterns were found and had a statistically significant association with the classical fracture lines (P < .0001).

CONCLUSION AND RELEVANCE: The authors conclude that the variations in fracture patterns encountered today may be attributed to the mechanism of injury. With due consideration to the limitations of this study, the authors suggest that the treatment plan may require slight modification based on the variation of the fracture pattern. Additional intervention may also be indicated.